Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients

Gennaro Nuzzo, Felice Giuliante, Francesco Ardito, Ivo Giovannini, Luca Aldrighetti, Giulio Belli, Fabrizio Bresadola, Fulvio Calise, Raffaele Dalla Valle, Davide F. D'Amico, Leandro Gennari, Stefano M. Giulini, Alfredo Guglielmi, Elio Jovine, Riccardo Pellicci, Heinrich Pernthaler, Antonio D. Pinna, Stefano Puleo, Guido Torzilli, Lorenzo CapussottiUmberto Cillo, Giorgio Ercolani, Massimo Ferrucci, Laura Mastrangelo, Nazario Portolani, Carlo Pulitanò, Dario Ribero, Andrea Ruzzenente, Vincenzo Scuderi, Bruno Federico

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154 Citations (Scopus)


OBJECTIVE: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. DESIGN: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. PATIENTS: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. MAIN OUTCOME MEASURES: Postoperative mortality, morbidity, overall survival, and disease-free survival. RESULTS: Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (right or right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P = .03 and P = .006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P = .05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. CONCLUSIONS: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.
Original languageEnglish
Pages (from-to)26-34
Number of pages9
JournalArchives of Surgery
Publication statusPublished - 2012


  • Hilar cholangiocarcinoma
  • Improved results
  • Klatskin tumor
  • Liver resection
  • Main biliary confluence excision
  • Results
  • Surgery


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